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■ The recipient continues to meet admission criteria as evidenced by active psychiatric <br />symptoms and continued functional impairment <br />■ Documentation indicates that symptoms are reduced, but discharge criteria have not been <br />met <br />■ The essential goals are expected to be accomplished within the requested time frame <br />■ Attempts to coordinate care and transition the recipient to other services have been <br />documented <br />IRTS Discharge Criteria <br />Discharge a recipient from IRTS when the recipient meets at least one of the following: <br />■ No longer meets continuing stay criteria <br />■ Has met ITP goals and objectives <br />■ Shows evidence of decreased impairment and appropriate, less restrictive community-based <br />alternatives exist <br />■ Has symptoms and needs that permit a lesser level of service and adequate supports and <br />services are in place <br />■ Is voluntarily involved in his or her ITP and no longer agrees to participate in the IRTS <br />services <br />■ Exhibits severe exacerbation of symptoms, decreased functioning, disruptive or dangerous <br />behaviors and requires a more intensive level of service <br />■ Has medical or physical health needs that exceed what can be brought into the residential <br />treatment setting <br />■ Does not participate in the program despite multiple attempts to engage him or her and to <br />address nonparticipation issues <br />■ Does not make progress toward treatment goals and there is no reasonable expectation that <br />progress will be made <br />■ Leaves against medical advice for an extended period (determined by written procedures of <br />provider agency) <br />Covered Services <br />Plan and coordinate IRTS with the local mental health service delivery system. Recipients may <br />access and receive services from the program outside of the facility when it would benefit the <br />continuity of treatment and transition to the community. The following services must be available <br />and offered as part of the program design: <br />■ Supervision and direction <br />■ Individualized assessment and treatment planning <br />■ Crisis assistance, development of health care directives and crisis prevention plans <br />■ Nursing services <br />■ Interagency case coordination <br />■ Transition and discharge planning <br />■ Living skills development, including: <br />■ Medication self -administration <br />0 Healthy living <br />